Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $197.00 / $197.00 / $216.70	Facility	26	$197.00	$197.00	$216.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $255.71 / $300.86 / $432.37	Professional		$255.71	$300.86	$432.37
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $156.71 / $187.16 / $286.75	Professional	26	$156.71	$187.16	$286.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.36 / $116.85 / $165.88	Professional	TC	$91.36	$116.85	$165.88
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $262.16 / $262.16 / $287.39	Professional		$262.16	$262.16	$287.39
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $167.67 / $259.50 / $259.50	Professional	26	$167.67	$259.50	$259.50
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $330.87 / $504.00 / $504.00	Professional		$330.87	$504.00	$504.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $196.76 / $389.86 / $712.87	Professional		$196.76	$389.86	$712.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $136.56 / $264.45 / $467.05	Professional	26	$136.56	$264.45	$467.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $86.43 / $162.32 / $297.24	Professional	TC	$86.43	$162.32	$297.24
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $327.23 / $423.37 / $550.66	Professional		$327.23	$423.37	$550.66
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $207.30 / $266.64 / $347.06	Professional	26	$207.30	$266.64	$347.06
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $119.93 / $156.72 / $203.59	Professional	TC	$119.93	$156.72	$203.59
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $134.58 / $246.51 / $423.67	Professional		$134.58	$246.51	$423.67
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $145.50 / $175.73 / $285.37	Professional	26	$145.50	$175.73	$285.37
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $92.43 / $114.27 / $198.64	Professional	TC	$92.43	$114.27	$198.64
United Facility/Professional Professional Modifier Low / Median / High Price $223.01 / $337.24 / $619.79	Professional		$223.01	$337.24	$619.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $137.13 / $211.72 / $370.44	Professional	26	$137.13	$211.72	$370.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $83.74 / $129.19 / $249.36	Professional	TC	$83.74	$129.19	$249.36